A case report of alverine-citrate-induced acute hepatitis / 대한간학회지

Alverine citrate is one of the most commonly used antispasmodic drugs for patients with irritable bowel syndrome. Alverine-citrate-induced hepatotoxicity is extremely rare, with only a few cases having been reported worldwide. We present a case of a 75-year-old female patient who experienced complicated jaundice and abdominal discomfort after taking alverine citrate. Other causes of hepatitis were ruled out and the results of the liver function test returned to normal after ceasing the drug. This is the first case report in Korea of alverine-citrate-induced hepatotoxicity.

The Effects of the Levering Laryngoscope on the Laryngoscopic View / 대한마취과학회지

BACKGROUND: The effects of the levering laryngoscope (McCoy laryngoscope) on the laryngoscopic view classified by the Cormack and Lehane were investigated in this study. METHODS: The laryngoscopic view with the levering laryngoscope blade in neutral and best position were recorded respectively and analysed statistically. RESULTS: 109 laryngoscopic views were grade 1 or 2 and 12 were grade 3 or 4 in the neutral position with the McCoy blade. Only three patients were grade 3 or 4 in its best position and the others grade 1 or 2. The reduction in the incidence of difficult laryngoscopic view (grade 3 or 4) using the levering laryngoscope in its best position was statistically significant (p<0.01). CONCLUSIONS: Levering laryngoscope improves laryngoscopic view and also reduces the incidence of difficult intubation. So, we suggest that it is an useful instrument for the anesthesiologists in the difficult tracheal intubation.

Right Cognition of Succinylcholine / 대한마취과학회지

Non-depolarizing muscle relaxant; d-tubocurarine was introduced clinically in 1942. Thereafter depolarizing muscle relaxant; succinylcholine was introduced in 1951. Those muscle relaxants were highly contributed in modern anesthesia practice today. But, since many years ago complications of succinylcholine were reported clearly so many anesthesia practice. Complications were such as ventricular arrythmia(cardiac arrest), fasciculation, hyperkalemia, muscle pain, elevation of intragastric, intraocular & intracranial pressure, prolonged apnea, generalized muscle clonus, masseter muscle rigidity and malignant hyperthermia etc. Succinylcholine was still used in clinical practice despite of many complications reported as long as more than 45 years. Finally, FDA(USA) decleared the routine use of succinylcholine was contraindicated in children and adolescents. Many textbooks of anesthesiology shows that use of succinylcholine was contraindicated in children and adolescents those were published recently since 1994. What is the current status of succinylcholine in despite of changing current concept of succinylcholine use in Korea? Succinylcholine is still inadvertently used in Korea over 79% of resident training hospital. Intravenous dantrolene reserve was only one hospital(1.4%). Undoubtedly, amazing things were going on in Korea. Seventeen cases of malignant hyperthermia had been reported from 1971 to 1996 on Korean medical journals. It's mortality was 70.6%. Not only the reported malignant hyperthermia, there are many cardiac arrest during anesthesia reported on Korean medical journals. Etiological analysis of cardiac arrest was reviewed some of them, there are certain numbers of cardiac arrest cases confirmed by succinylcholine was guilty. What is the counterplan? Change the current concept of succinylcholine is important. Conclusions ; 1. Non-depolarizing mucle relaxant should be used for intubation &/or muscle relaxation. 2. Hot line for malignant hyperthermia should be established.. 3. Intravenous dantrolene reserve is necessary. 4. Routine monitoring during anesthesia should be blood pressure, ECG, SPO2, ETCO2, body temperature and peripheral nerve stimulator.

The Time of Neostigmine Antagonism for the Rapid Recovery of Profound Muscle Relaxation in Rabbits / 대한마취과학회지

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.

Influence of Succinylcholine on the Potency of Vecuronium at the Larynx and the Adductor Pollicis / 대한마취과학회지

No abstract available.

The Hemodynamic Changes Induced by Doses of Propofol / 대한마취과학회지

BACKGROUND: Propofol(2,6 diisopropylphenol) is a potent hypnotic currently formulated as an oil-in-water emulsion. Although previous studies reported decreases in arterial pressures and heart rate, no detailed studies of hemodynamic effects of propofol administration alone are available in Korea. This study is to determine the hemodynamic changes induced by doses of propofol. METHODS: Sixty patients(ASA physical status 1 or 2) were divided randomly into three groups as follows: group I, pmpofol 1.5 mg/kg; group 2, propofol 2.0 mg/kg; group 3, propofol 2.5 mg/kg. Heart rate and mean arterial pressure were measured by Datascope 2200I, and cardiac index(CI) and systemic vascular resistance index(SVRI) were obtained by doppler cardiac output monitor(Datascope Accucom 2) at the suprasternal notch before and after induction of propofol. RESULTS: Statistically significant decreases in mean arterial pressure were observed since 2 min after induction. CI was decreased from 2.94+/-0.51 to 2.35+/-0.57 L/min/m(2) at 6 min after induction of propofol 2.5 mg/kg, and no differences among groups. CI was also decreased in group 1 and 2 but without any significance. SVRI was decreased in all groups but there were no significance, and no differences among groups. CONCLUSIONS: The data suggest that the usual doses of propofol do not significantly cause hemodynamic changes, and a decrease in mean arterial pressure is a result of decreased CI and reduced SVRI.

Effect of K+ channel Blocker on Vasodilation by Halothane / 대한마취과학회지

Halothane is a popular inhalation anesthetics in practice, which has been reported to cause a vasodilation through a direct depressant action on vascular smooth muscle, or by an indirect attenuation of vasoconstrictor activity. The membrane potential of the vascular smooth muscle cell is mainly regulated by the flow of Ca2+ and K+ ions through specialized channels. The purpose of this study was to determine whether blockade of the K+ channel alter the response to halothane vasodilating action. This study was done with rat thoracic aorta in tissue bath. Isometric tension of the ring (3~4 mm in length) was recorded. In halothane alone group (n=15), after precontraction with norepinephrine (10(-7) M), ring was exposed with halothane 0.7%, 1.5%, 2.1% concentration for 15 minutes, sequentially. The procedure of calcium activated K+ channel blocker pretreated group (n=12) was same manner as halothane alone group after tetraethylammonium (TEA 20 mM) pretreatment. The result of this study was shown to followings; 1) Vasodilation correlate with halothane concentration (p<0.05). 2) Vasodilation in tetraethylammonium (TEA) pretreated group also augmented 'significantly (p<0.05). 3) Especially, in the halothane 1.5%, 2.1%, the presence of TEA significantly potentiate vasodilating effect: halothane alone group, -35%, -53%: TEA group, -47%, -71%(p<0.05). These result demonstrate that: 1) halothane induce relaxation of rat aorta. 2) K+ charinel blokade potentiate the vasodilating effect of halothane.

Mechanism of Hypoxic Pulmonary Vasoconstriction in the Isolated Rabbit Pulmonary Artery / 대한마취과학회지

Hypoxic pulmonary vasoconstriction(HPV) plays an important role in matching ventilation and perfusion, and in a homeostatic compensatory mechanism for maintaining arterial blood oxygen tension. The purpose of this study was to explore effect of hypoxia on the vascular tension and to elucidate mechanism underlying hypoxic pulmonary vasoconstriction. The ring segments of the pulmonary artery were taken from forty rabbits(2~2.5 kg, male). Each ring was attached to an isometric force transducer(Grass FT-03) and suspended in a tissue bath(37degrees C) filled with 5 ml Krebs solution, aerated with 95% O2 + 5% CO2(pH 7.4) gas mixture. During 90 minutes of equilibrium period, the Krebs solution was changed every 15 minutes and the last resting tension was adjusted to 2 gm. After precontraction of the preparations with K(+) 40 mM, the aerating gas mixture was replaced by hypoxic gas(95% N2 + 5% CO2) and changes in vascular tension of isolated pulmonary artery with(n=36) and without endothelium(n=14) were recorded for 60 minutes. HPV induced biphasic vasoactive effects. To determine the mechanism of the vasorelaxing response, the pulmonary arterial rings were pretreated with indomethacin(n=8), L-nitro(w) arginine methyl ester(L-NAME, n=l0), tetra ethyl ammonium(TEA, n=12), glybenclamide(n=l1). And also to elucidate the mechanism of the hypoxic vasoconstricting response, effects of Ca free solution and pretreatment of ryanodine on the HPV were examined. The results obtained were as follows: 1) Transient phase 1 contraction followed by long lasting(about 30 minutes) relaxation and sustained phase 2 contraction were induced by hypoxic gas(95% N2+5% CO2) in rabbit pulmonary artery. 2) In endothelium removed pulmonary artery, transient phase 1 contraction was not apparent. 3) Vasorelaxation was partially blocked by K' channel blockers(TEA, glybenclamide). 4) Indomethacin and L-NAME pretreatments did not affect on the vasorelaxing response of the HPV to hypoxia. 5) Sustained phase 2 contraction was blocked by calcium free Krebs solution. 6) Indomethacin and ryanodine pretreatments did not change the phase 1 and phase 2 vasocontsricting reponses. The results of present study suggest that hypoxia-induced phase 1 contractile response is endothelium dependent, while phase 2 contractile response is dependent on calcium influx, and that the vasorelaxant response is partially mediated by K(+) channel.

Clinical Neuromuscular Monitoring by TOF and DBS3,3 / 대한마취과학회지

Why anesthesiologists use the muscle relaxants? Because muscle relaxants are an adjunct to modem anesthesia practice today. What should be pepared whenever using a muscle relaxant? Of course, its necessary for artificial respiration. Why should be anesthesiologists monitor the neuromuscular blockade? There are so many factors affecting neuromuscular blockade. Factors are ; individual difference, age, sex, bady fluid, drug interactions including muscle relaxants themself and more than 250 drugs including anesthetics and antibiotics, disease states, hypothermia etc. That why anesthesiologists should know the degree of neuromuscular blockade. Whenever assurance on the degree of neuromuscular blockade is essential to the modern anesthetic practice. Observation of the motor response to peripheral nerve stimulation is helpful. Use of the peripheral nerve stimulator for monitoring of the neuromuscular blockade must be made mandatory whenever muscle relaxants are used. This study was performed 50 healthy patients. Ulnar nerve-adductor pollicis was stimulated simultaneously both hand by TOF and DBS3,3 each, during intubation dose of vecuronium 0.1 mg/kg and same stimulation was given both hand during anesthetic maintenance by intermittent bolus of vecuronium 1-2 mg during surgery. Number of twitch was counted by each TOF and DBS3,3 in the same time and onset time (TOF, TO) and time for reappearance of TOF, Tl was measured. Results were as follows ; 1) Simple, by use of peripheral nerve stimulator. 2) During onset time ; TOF twitch was disapperared earlier than DBS3,3. 3) During recovery phase ; DBS3,3 twitch was appeared earlier than TOF. 4) Onset time was 215.4+/-54.04 sec. and TOF, Tl reappearance was 1,793.4+/-487.61 sec. 5) Clinical evaluation of neuromuscular function was more reliable by number of twitch count with ulnar nerve-adductor pollicis on TOF than DBS3,3.

The Effect of Thiopental on the Isolated Rabbit Abdominal Aorta / 대한마취과학회지

The characteristics of an ideal intravenous anesthetic agent include stability in solution, rapid onset of action, minimal effect on the cardiovascular and respiratory systems, short elimination half life, and minimal side effects. Using this criteria, the ultra-short acting barbiturate, thiopental has long been considered the gold standard of intravenous agents used for induction of anesthesia. In normovolemic subjects, thiopental produces a transient decrease in blood pressure, and increase in heart rate. In practice, thiopental is administered high dose(30 mg/kg IV) for brain protection, rarely. We tried to confirm the direct vascular effects of thiopental and its mechanism on the rabbit abdominal aorta in vitro. The rabbit abdominal aorta were precontracted with norepinephrine(10(-7) M) in 5 ml tissue bath and 10(-5), 10(-4), and 10(-3) M thiopental was administrated in cumulative manner. Ten minutes later, changes of the vascular tones were obtained. For confirming the relaxing mechanism induced by thiopental, experiment was performed by indomethacin, methylene blue and LNAME pretreatment, and endothelium removed, respectively. The results were as follows 1) Thiopental at 10(-5), and 10(-4) M produced no signifcant changes, and at 10(-3) M produced signifcant relaxation. 2) There were no significalnt difference in their vascular tones between intact and denuded endothelium group. 3) The vascular tones were not affected by LNAME, methylene blue, and indomethacin pretreatment. These results suggest that thiopental induce vasorelaxation in rabbit abdominal aorta at high concentration(10(-3) M). The vasorelaxation mechanism is not correlated with NO, cyclic GMP, prostacyclin and endothelium.

The Influence of Thiopental Sodium , Ketammine and Lidocaine on the twitch recovery after Vecuronium Bromide / 대한마취과학회지

Anesthetic drugs by themselves were without effect on neummuscular function, but when the margin of safety in transmission was reduced, because of the admimstration of a musde relaxant, then a synergistic effect on relaxation might be observed. The purpose of this study was to examine whether the twitch recovery after vecuronium bromide (vecuronium) was influenced by thiopental sodium (thiopental), ketamine and lidocaine. Eighty healthy adult patients were randomly allocated to four groups according to the drugs, control group, normal saline 5 ml, study group ; 2.5% thiopental 5 mg/kg, ketamine 2 mg/kg and 1% lidocaine 1 mg/kg. Neuromuscular bloek was induced by intravenous vecuronium 0.1 mg/kg and applied ulnar nerve stimuli of every 10 seconds single twitch using Myotest Mk II(R). The adduction force of the resultant thumb twitch was measured by the acceleration of a small piezo-electric ceramic wafer with electrodes of Mini-accelograph(8) and recorded by Datascope 2200I(8). When the twitch height was near 15 mm, the drug was injected and recorded the twitch height for 10 min. and checked mean arterial pressure and heart rate after injection. The results were as follows ; 1) There were no significant changes of mean arterial pressure after drug injection. 2) Heart rate was significantly increased in thiopental group (77.7+/-8.3 beats/min. 93.7+/-9.1 beats/min.) and lidocaine group (85.6+/-15.9 beats/min. - 88.4+/-16.4 beats/min.), but no change in control and ketamine group. 3) In the linear regression analysis between the twitch length and the time, control group was Y=16.0+/-1.0X, r2=0.33, thiopental group was Y=14.9+/-1.1X, r2%.39, ketamine gmup was Y=14.8+0.9X, r2=0.24 and lidocaine group was Y=15.1+0.8X, r2=0.30. Lidocaine group was only significantly decreased than control group. With the above results the authors concluded that the twitch recovery after vecuronium was significantly deaeased by lidocaine, but no cbanges by thiopental and ketamine. We should more find the drug interaction with vecuronium in the man.

The Effect of Intravenous Solu-cortef on Vecuronium Induced Muscle Twitch Height Rabbit / 대한마취과학회지

It is a widespread clinical practice to administer large doses of corticosteroids to patients in cases of shock and or neurosurgery; corticosteroids given intravenously have been proposed and used. Corticosteroids, when administered in this way during surgery have been implicated in intera- ctions with neuromuscular blocking agents. Therefore, the effects of Solu-cortef in the neuromuscular blockade produced by vecuronium were studied in vivo on the indirectly stimulated tibialis anterior muscles of the rabbits aneth- etized with urethane and pentothal sodium. Control group of rabbits was given intravenous boius of 0.1 mg/kg vecuronium to produce twitch depression and recovery as recorded by biophysiograph and measured at anterior tibialis muscle twitch in response to common peroneal nerve by double burst stimulation (DBS). First study group (S-l group) of rabbits was given intravenous bolus of 16 mg/kg Solu- cortef thirty minutes before, and then 0.1 mg/kg vecuronium intravenous bolus was given. Twitch depression and recovery was measured as control group. Seeond study group (S-2 group) of rabbits was given intravenous bolus of 0.1 mg/kg vecuronium during recovery phase, intravenous bolus of 16 mg/kg Solu-cortef was given at DBS ratio 0.5. Statistical analysis was confirmed by oneway ANOVA test,followed by Student- Newman-Keuls test. The results were as follows', 1) In control group,'recovery times to DRS ratio at 0.5 and 0.8 were 1,089.2+42.94 and 1,272.0 +'54.87 sec. 2) In first study group',axovery times to DBS ratio at 0.5 and 0.8 were 1,208.8>61.95 and 1,417.4+65.02 sec. It shows some what prolonged recovery time than control but statistically not significant. 3. In second study group;recovery times to DBS ratio at 0.5 was 1,218.4+/-61.16 sec. DBS ratio was deereased to 0.22 when intravenous bolus of Solu-cortef was given,thereafter DBS ratio was gradually increased Recovery times to DBS ratio at 0.5 and 0,8 were 1,444.0 and 1,633.8+/-65.02 sec. More prolonged recovery times were observed. It was statistically significant to compare with control and first study group (P<0,05). By the above results ; acute intravenous bolus Solu-cortef may affeet the vecuronium induced neuromuscular block in rabbits.

The Vascular Effect of Ketamine Hydrochloride on The Isolated Rabbit Pulmonary ArteryC / 대한마취과학회지

Ketamine hydrochloride is a phencyclidine derivatives and dissociative anesthetics. Ketamine induce the pulmonary vasoconetrietion in vivo. This study was designed to deter- mine the direct effect of the ketamine on the rabbit pulmonary artery in vitro. Isolated pulmonary artery was precontracted with norepinephrine (NE) 10-7M in the 20 ml organ bath. Concentration of ketamine was gradually increased 10-5M, 10 4M and 10-3M at 10 minutes intervals. I divided forty three experimental speeimens into 5 groups : pulmonary artery with and without endothelium, pretreated with indomethacin, nitrow-L-arginine methyl ester(L-NAME) and methylene blue. The results were as follows : 1. Norepinephrine precontracted pulmonary arterial tone wss significantly decreased by ketamine(10-3M), and the relaxing percent were 81.0 19.3, 60.6 55.4 (Mean S.D.) in unrubbed and rubbed endothelium, respectively (p<0.05). 2. The changes of vascular tone in denuding and intact groups were not significantly different. 3. Vasorelaxation induced by ketamine was not related with nitric oxide(NO) synthase, cyclooxygenase and soluble guanylate cyclase. Ketamine induce relaxation of the rabbit pulmonary artery, especially at 10-3 M concentra- tion. The relaxing effect was not related with endothelium presence, nitric oxide synthase, cyclooxygenase and soluble guanylate cyclase pathways. This data suggest that the relaxing effect of ketamine was not associated with endothelium, Nitric oxide, prostacyclin and cyclic guanosinemonophosphate.

Assessment of Facial Nerve Stimulation Methods to Determine the Optimal Time for Tracheal Intubation after Vecuronium Injection / 대한마취과학회지

Absence of response to train of four(TOF) and single twitch stimulation at ulnar nerve did not guarantee ided intubation conditions after vecuronium. The double burst stimulation (DBS) introduced by Viby-Mogensen, made it easier to evaluate postoperative residual neuromuscular blockade manually than did the use of the TOF method. The purpose of this study was to examine which will be the best stimulus among DBS, TOF and single twitch stimulation(STS) for an indicator of the optimal time for tracheal intubation. One hundred and nine healthy patients were randomly allocated to three groups in which DBS(n=34), TOF(n=38) and STS(n=37) group. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained 1% enflurane until intubation. Neuromuscular block was induced by intravenous vecuronium0.1 mg/kg, and applied facial nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher and Paykel Co.) continuously. The complete relaxation time of orbicularis oculi muscle was closely observed with authors naked eyes. Tracheal intubation was performed immediately by the author after disappearance of the response to stimuli. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cords opening, coughing reflex and response to laryngoscopy attempts. The intubation time was 195.9+/-74.7(90-390) seconds in DBS group, 180.9+/-49.8(100-290) seconds in TOF group and 167.7+/-37.9(90-270) seconds in STS group and there were no statistically significant difference. There were also no significance on vocal cords opening and response to laryngoscopy attempts in three groups but DBS group was statistically less cough reflex than TOF group and STS group(p<0.05). With the above results the authors concluded that DBS on the facial nerve with the orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation and the time was about l96 seconds after vecuronium.

Assessment of Facial Nerve and Ulnar Nerve Stimulation Methods to Determine the Optimal Time for Tracheal Intubation / 대한마취과학회지

Stimulation of ulnar nerve and. measurement of adductor pollicis response have been used for many years in clinical practice and research, but different muscles respond differently to relaxants, both in terms of onset and duration of blockade. The onset time of neuromuscular blockade at the vocal cords and at the orbicularis oculi muscle(OO) was similar, and was shorter than at the adductor pollicis muscle(AP). The purpose of this study was to examine which will be the best stimulus among double burst stimulation(DBS), train of four(TOF) and single twitch stimulation(STS) on OO or AP for an indicator of the optimal tiime for tracheal intubation. Two hundreds and thirty six healthy patients were randomly allocated to six groups in which DBS(n=34), TOF(n=36) and STS(n=37) group in OO group, and DBS(n=43), TOF(n=43) and STS(n=43) group in AP grouy. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained with 1% enfluraae until intubation. Neuromuscular block was induced by intravenous vecuronium 0.1 mg/kg and applied facial nerve or ulnar nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher & Paykel Co.) continuously. The complete relaxation time of OO group was closely observed with authors naked eyes, but the time of AP group were measured by tactile response of thumb. Tracheal intubation was tried immediately by the author after complete disappearance of the muscle contraction. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cord opening, coughing reflex and response to laryngoscopy attempts. The results were as follows: 1) The intubation time of OO group was 195.97+/-12.82 sec. in DBS group, 182+/-8.46 sec. in TOF group and 167.73+/-6.24sec. in STS group, respectively and there were no significance among groups. 2) The intubation time of AP group was 290.56+/-12.1sec. in DBS group, 276.79+/-10.32sec. in TOF group and 230.16+/-9.88sec, in STS group, respectively and there were no significance among groups. But the intubation time of AP group was significantly prolonged more than that of OO group. as much as 95 sec. of DBS group, 94 sec. of TOF group and 63 sec. of STS group, respectively(p<0.05). 3) There were no significance of vocal cords opening and response to laryngoscopy attempts in three groups, but DBS group(6%) was statistically less cough reflex than TOF(37%) and STS group(33%) in OO group(p<0.05). There were no significance of the intubation responses among three groups in AP group. 4) Coughing reflex ratio(positive cough cases/total cases X 100) of OO group(36%) was significantly more than that of AP group(12%) in TOF group, and coughing reflex ratio of OO group (32%) was significantly more than that of AP group(12%) in STS group, but there were no significance of coughing reflex ratio between OO and AP group in DBS group. With the above results the authors concluded that DBS on facial nerve observed orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation, and facial nerve stimuli was more sensitive than ulnar nerve stimuli due to reduce 95 sec. of intubation time. The optimal intubation time was about 196 sec. after vecuronium(0.1 mg/kg).

The Effect of Pentaspan on The Vascular Tone of The Isolated Rat Abdominal Aorta and Renal Artery / 대한마취과학회지

The Pentaspan is a high molecular weight(250,000), hyperosmolar(320 mOsm/l) colloid solution and blood volume expander in clinical practice. Many researches revealed the decreasing of systemic vascular resistance and pulmonary vascular resistance after Pentaspan administration in vivo. Some colloid solution is contraindicated in acute renal failure. We tried to confirm the direct effects of the Pentaspan and its mechanism on the abdominal aorta and renal artery in vitro. The rat abdominal aorta and renal artery were precontracted with norepinephrine(10(-7) M/1) in 50 ml Krebs solution and 5 ml Pentaspan was infused. Ten mininutes after, changes of the vascular tones were obtained. The results were as follows. 1) The vascular tones were significantly decreased in both vessels. 2) Abdominal aorta group, renal artery group and with or without endothelium group were not significant different each other. 3) The vascular tones were not affected by with or without endothelium, indomethacin and methylene blue pretreatment. Smooth muscles were induced relaxation by the Pentaspan infusion and the relaxation were not dependent to endothelium derived relaxing factor, prostanoid and cyclic guanosinemonophosphate.

A Case of Removal of Pheochromocytoma with Enflurane and the Variation of Catecholamine in the Blood / 대한마취과학회지

The Department. of Anesthesiology of Hanyang University had a case of operation for pheo- chromocytoma. For the operation of pheochromocytoma, used to prazosin for preoperative treatment of hypertension and used to enflurane as inhalational anesthetic, treated with sodium nitroprusside for severe elevation of blood pressure during operation, used to vecuronium for neuromuscular blocker. Also we tried to get the knowledge about the variation of catecholamine concentration in blood through operation. As we used to the other drugs with adequate amount of fluid without any other complication in this operation we reported here with other references and our experience of a case of operation for remove of pheochromocytoma.

The Study about the Accuracy of Diacan - S When Had Used to Glucose Oxidase Method and Diascan - S for Blood Glucose / 대한마취과학회지

On department of anesthesiology, Hanyang university hospital, we used to the Diascan-S for portable blood glucose monitoring during surgery with anesthesia. So, we try to know about the accuracy, the precision and the specificity of that instrument. Period to check for blood glucose was devided to 3 groups that are on just after induction, the operation of main lesion, the end of surgery and we compared to the blood glucose level by the Diascan-S and the standard reference test. Central laboratory used glucose oxidase method to check blood glueose as the standard reference test. Thereafter we got the conclusions as follow. 1) We had got to good correlation between the blood glucose level by Diascan-S and the stan-dard reference test. (Y=65+0.64X, correlation coefficiency 0.58, p value; 0.0000) 2) When the blood glucose levels had devided as below from l00 mg/dl, 100 mg/dl to 150 mg/ dl and above 150 mg/dl, we only got to good correlation blood glocose level by Diascan-S and the standard reference test from 100 mg/dl to l50 mg/dl. (Y=11+2.5X, correlation coefficieny ; 0.51, p value ; 0.0000) 3) When we had tested for blood glucose on ]ust after anesthesia induction and the operation on main lesion, the end of surgery, the results of each period have a good correation each other by Diascan-S and the standard reference test. (a) Just after anesthesia induction Y = 51+0.50X, correlation coefficiency 0.52, p value 0.0000 (b) Operation for main lesion Y = 80+0.38X, correlation coefficiency 0.45, p value 0.0000 (c) End of surgery Y = 61+0.54X, correlation coefficiency ; 0.62, p value 0.0000 4) The condition of instrument had devided to two conditions of Diascan-S as was calibrated by technician reqularly or not, got to more confident correlation coefficiency when the Diascan-S had calibrated by technician reqularly. (a) had calibrated reqularly Y = 40+0.62X, correlation coefficiency 0.65, p value: 0.0000 (b) had not calibration Y = 77+0.42X, correlation coefficiency ; 0.36, p value: 0.0026 By above results, we got conclusions that portable glucose monitoring instrument(Diascan-s) can use to know to change of blood sugar during anesthesia. And then, if we got the result of blood glucose level as belows 100 mg/dl or above 150 mg/dl when used Diascan-S, should try to test again and must compared to standard reference test of central laboratory. Diascan-S must be ca)ibrated by technician reqularly if we try to get more accurate results of blood glucose by Diascan-S.

Effect of Muscle Relaxation by Domestic Product of Metuben in Rabbit / 대한마취과학회지

The domestic product of a non-depolarizing muscle relaxant, Metuben, was studied on its effect in rabbit. Twenty four rabbits of either sex weighing 2~3kg were divided into four groups (consisting of 6 animals each) to administer Metuben in doses of 0.05 mg/kg, O.l mg/kg, 0.2 mg/ kg and 0.4 mg/kg, respectively. All animals were anesthetized with 20% urethane 5 ml/kg given intraperitoneally and 2.5% pentothal sodium 10 mg/kg intravenously. ECG was monitored by Physio-contro1(lifepak 7)model. The animal lungs were mechanically ventilated through a tracheostomy and Shinano animal respirator set to deliver a 30 ml/kg tidal volume at 30 breaths/min. This ventilatory pattern resulted in the PaCO2 values within the range of 30-40 mmHg. Twitches of the tibialis anterior muscle were elicited at 0.1 Hz, "Train of four" via the peroneal branch of the sciatic nerve, and the Myotest stimulator were applied at supramaximal voltage. Twitch recording was done via Biophysiograph. Results were as follows: 1) The effect of Metuben as a dose-dependent long lasting non-depolarizing muscle relaxant was confirmed. Their relaxant effect in rabbits were quite different from man. 2) In rabbits, Metuben showed great individual differences in its effect even with the s'ame dosage. The length of muscle relaxing activity.and the occurence of recurarization after neostigmine reverse were extremely variable suggesting its safety margin is quite narrow.

Comparison of the Recovery from Pancuronium-induced Neuromuscular Blockade in Rabbit by Different Method of Nerve Stimulations / 대한마취과학회지

The methods commonly used for monitoring neuromuscular transmission do not allow evaluating of an intense neuromuscular blockade. A sufficient dose of non-depolarizing relaxant used for endotracheal intubation causes disappearance of the response to single, tetanic and train of four (TOF)nerve stimulation for a variable period of time during which the magnitude of neuro-muscular blockade can not be evaluated by the traditional stimulation forms. Enhancement of posttetanic twitch tension in partially curarized patients remains constant regardless of the dose of non-depolarizing muscle relaxant or magnitude of neuromuscular blockade. If this also holds true for an intense neuromuscular blockade, the response to posttetanic twitch stimulation after the injection of a non-depolarizing muscle relaxant must appear earlier than the response to pretetanic twitch or TOF neve stimulation. The present study was designed to evaluate neuromuscular blockade during the period of no response to single or TOF stimulation by quantifying the degree of posttetanic potentiation. The possibility existed that the relatively frequent use of a tetanic stimulation (every 6 minutes) might have influenced the recovery of neuromuscular blockade. Therefore, we have studied the conventional TOF stimulation comparing with posttetanic count stimulation which may affect the recovery of intravenous pancuronium(0.08 mg/kg) induced neuromuscular block. The results were as follows; 1) The time of the T1 appearance was 815 seconds and 50% T4 ratio was 1,214.3 seconds in TOF group. 2) The time of the T1 appearance was 790 seconds and 50% T4 ratio was l,l35.5 seconds in PTC group, The recovery time appeared to be shorter in this group but statistically not signifi cant. 3) ln PTC group, TOF recovery was observed after average 2.3 times of tetanic stimulation. Above findings may suggest that intense pancuronium block in rabbit is not affeced by the TOF or PTC stimulation.